New resolutions for primary care

by KIM N. ARREY  January 2012

This year, it would be great if doctors, in particular primary-care physicians, resolve to genuinely help their overweight and obese patients. Many try to simplify the message to its most basic: eat less and move more. Science, however, tells us that losing weight and maintaining it is more complicated than we think. Here are five strategies to help you help your patients.

The Edmonton Obesity Staging System

Most doctors use BMI and possibly waist circumference to determine if a person is overweight. While this is great information to have, it doesn’t indicate the severity of the problem. With other diseases, a staging system is used to classify risk and to help physicians decide treatment. Developed by a team of researchers in Edmonton, the Obesity Staging System takes into account anthropometric measurements, comorbidities and functional status to assess a patient. It’s been proven as a better predictor of mortality than conventional methods.1 Practitioners may be better able to help patients who are most in need and not waste time treating the healthy obese.

The four Ms

Learn how the different Ms influence a patient’s choices. According to Dr Arya M. Sharma, the founder and director of the Canadian Obesity Network, the four Ms of obesity management are Mental, Mechanical, Metabolic and Monetary. Each area needs to be assessed before making recommendations. A client who is overweight and has ADHD might require different strategies than someone who doesn’t.2

Make your office weight-management friendly

Many clients are uncomfortable discussing weight issues and feel discriminated against. Is your office welcoming to the overweight? Do the chairs have arms? Is your scale in the waiting room or in a private area? Does your staff make comments to patients regarding their weight? Are the blood-pressure cuffs large enough? Weight discrimination is rampant in society and medical offices are no different.3

Encourage reasonable goals

Studies show that many clients have unrealistic expectations about how much weight they can lose and should lose. For health reasons, experts now recommend a loss of between five and 10 percent of one’s initial weight.4 That means that someone who weighs 90 kilograms should be encouraged to lose between 4.5 and nine kilograms. A person who is 157 centimetres tall may find this unsatifactory.5